Healthcare Provider Details

I. General information

NPI: 1750522645
Provider Name (Legal Business Name): MS. SANDY JUSTINE LUCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 HIGH ST
DELANO CA
93215-2960
US

IV. Provider business mailing address

ATTN QUALITY AND RISK MANAGEMENT PO BOX 1559
BAKERSFIELD CA
93302-1559
US

V. Phone/Fax

Practice location:
  • Phone: 661-725-2788
  • Fax: 661-725-1957
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-326-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: